Models Addressing Breastfeeding

Exclusive breastfeeding for the first six months of life, and continued breastfeeding with supplemental foods for at least the first year of a child's life, is the best possible nutrition for infants, according to the American Academy of Pediatricians. Women also benefit from breastfeeding. Women who breastfeed have lower chances of developing multiple chronic diseases, including premenopausal breast cancer, ovarian cancer, weight gain, diabetes, and metabolic syndrome.

Women in rural areas are less likely to initiate breastfeeding than women in urban areas. Community breastfeeding support groups are often held at community centers, clinics, or hospitals. However, in-person support groups are not available in all rural communities. There is strong evidence that programs that promote breastfeeding increase initiation and duration of breastfeeding.

One emerging, innovative effort to help women in rural areas breastfeed is telelactation. This intervention is typically delivered through a mobile device application and offers on-demand consultations with certified lactation experts who provide breastfeeding guidance and educational materials to mothers. Support may also be available through traditional phone calls, video chats, text messages, or online communities. Telelactation also connects breastfeeding women to each other, which leads to the organic development of virtual support groups. These emerging programs have partnered with WIC agencies, research institutions, and community coalitions to fund and deliver care.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a resource for breastfeeding support for mothers who are income-eligible to receive services. WIC provides peer counseling services, which is support provided by peers, such as a community health worker. There is evidence that peer counseling programs are effective at increasing initiation rates and duration of breastfeeding.

Some state WIC programs have also implemented digital tools to support breastfeeding, including 24/7 breastfeeding support via video calls and text support programs, both of which have been well received and address geographic barriers.

Human milk banks are facilities around the country that collect, screen, process, and dispense breast milk. The breast milk comes from lactating mothers who are eligible to donate their breast milk. Premature or other eligible special needs babies who have circumstances that do not allow the mother to provide breast milk may be eligible to receive a prescription for donor breast milk. Healthy, full-term babies often do not qualify for prescriptions, as donor milk is available in limited quantities and expensive ($3-$5 per ounce). While insurance companies rarely cover this, milk banks will often work with the family to obtain coverage for the processing fees of the milk. Medicaid in some states also covers the costs associated with donor breast milk.

Examples of Models Addressing Breastfeeding

• La Leche League, a volunteer-operated international group of breastfeeding advocates, offers community-based support groups across the world. Extremely isolated rural or frontier communities may offer virtual options in lieu of in-person La Leche League meetings. Inspire.com is an online support group and discussion community for breastfeeding support. Facebook is another platform where breastfeeding mothers can find support, including groups such as La Leche League and Black Moms Breastfeeding Support Group.
• Mother's Milk Bank of South Carolina reported as much as 260,000 ounces of donated milk per milk bank site — two of which are located in rural counties — and over 186,000 ounces of milk delivered to the NICUs in a single state.

For more information on breastfeeding, visit the First Year of Life and Breastfeeding section of the Rural Early Childhood Health Promotion Toolkit.

Program Clearinghouse Examples

• Mississippi WIC
• Good Beginnings of Central Vermont

Considerations for Implementation

There is strong evidence that paid family leave can increase breastfeeding initiation and duration. A lack of maternity leave is a major barrier to breastfeeding. There is some evidence that workplace supports for breastfeeding may increase the likelihood of women exclusively breastfeeding for six months after birth. Workplace supports differ between employers, but may include enabling access to lactation rooms, sufficient breaks to nurse or express milk, telework, babies at work, extended maternity leave, or flexible schedule options. One study found that in rural areas, many employers do not offer sufficient space or breaktime for mothers to breastfeed.

As discussed earlier, evidence indicates that peer support programs increase breastfeeding rates. However, implementing peer programs in rural communities may require additional resources. Purchasing cell phones for peer counselors may be necessary, for example, so the counselors do not need to use their personal phone plans to communicate with clients. Another possible adaptation to account for distance would be purchasing laptops and developing a web-based interface so peer counselors could work at home or the client's home and still allow their supervisor to monitor the interactions.

Other barriers to breastfeeding faced by rural women include: lack of access to information and education about breastfeeding, lack of support services, and geographic and social isolation.

Resources to Learn More

The Academy of Lactation Policy and Practice (ALPP)
Website
A national organization offering a certification program promoting evidence-based knowledge and clinical care on breastfeeding and human lactation for a variety of professionals working with families to promote and support breastfeeding. Includes a searchable registry by state and ZIP code of certified lactation counselors.
Organization(s): Academy of Lactation Policy and Practice, Inc. (ALPP)

Breastfeeding in the Community: Program Implementation Guide: Reducing Disparities in Breastfeeding through Peer and Professional Support, 2014-2018
Document
Offers resources and guidance to help local health departments and community-based organizations develop, implement, and sustain evidence-based peer and professional lactation support programs.
Organization(s): National Association of County and City Health Officials (NACCHO)
Date: 10/2018

Breastfeeding Resources for Child Health and Disability Prevention (CHDP)
Website
Offers a variety of recommendations and clinical guidelines for healthcare providers when helping mothers and their babies with breastfeeding. Includes a list of county resources in California.
Organization(s): California Department of Health Care Services

Indigenous Breastfeeding Counselors (IBC) Certification
Website
An introductory lactation education course developed and designed by Natives for counselors providing breastfeeding support to Native families.
Organization: Center for Health Equity, Education, & Research (CHEER)